1
Q
How is the infant epidermis different from older children and adults?
A
The epidermis is thinner and blood vessels are closer to the surface.
2
Q
How does infant skin affect heat loss?
A
Infants lose heat more readily through the skin surface than an older child.
3
Q
How does absorption differ in infant skin?
A
Substances are more easily absorbed through the skin.
4
Q
How does water content differ in infant skin?
A
Infant skin contains more water.
5
Q
How are the epidermis and dermis connected in infants?
A
The epidermis is loosely bound to the dermis.
6
Q
What effect does friction have on infant skin?
A
Friction more easily results in blistering or skin breakdown.
7
Q
How does pigmentation affect infant skin risk?
A
Less pigmented skin has an increased risk for UV damage.
8
Q
How is temperature regulation different in infants?
A
Temperature regulation is less effective compared to older children and adults.
9
Q
What is the status of sebaceous and sweat glands at birth?
A
They are immature at birth and mature during puberty.
10
Q
When does skin reach adult thickness?
A
In late teen years.
11
Q
How does darker skin differ in healing response?
A
Darker skin has more hypertrophic scarring and keloids.
12
Q
Why can bacteria gain access more easily through infant and young child skin?
A
Bacteria can gain access more readily through infant and younger child skin than through adult skin.
13
Q
What type of rash occurs with diaper candidiasis?
A
A bright red rash with satellite lesions.
14
Q
What are characteristics of fungal diaper infection lesions?
A
Fiery red lesions and scaling in the skin folds.
15
Q
What are satellite lesions?
A
Lesions located further out from the main rash.
16
Q
When can fungal infection occur in the diaper area?
A
When fungus thrives in warm/moist areas.
17
Q
What conditions increase risk for diaper candidiasis?
A
• Area not kept clean and dry • Taking antibiotics or mothers taking antibiotics while breastfeeding • Having more frequent stools
18
Q
What is the antifungal treatment for diaper candidiasis?
A
Topical nystatin with diaper changes for several days.
19
Q
What causes diaper dermatitis?
A
A nonimmunologic response to a skin irritant.
20
Q
Does diaper dermatitis usually result in a bumpy rash?
A
No, it does not usually result in a bumpy rash.
21
Q
How does diaper dermatitis typically begin?
A
Starts as a flat red rash in the convex skin creases.
22
Q
What does diaper dermatitis look like?
A
Red and shiny; may or may not also have papules.
23
Q
What is the main treatment approach for diaper dermatitis?
A
Provide a barrier to the skin.
24
Q
What topical products may be used for diaper dermatitis?
A
Ointments or creams containing vitamins A, D, and E; zinc oxide; or petrolatum.
25
What is a wet dressing?
A dressing moistened with lukewarm water (sterile water may be required in certain cases).
26
When are wet dressings indicated?
In the presence of itching, crusting, or oozing to help remove crusts.
27
What are nursing implications for wet dressings?
May use Burow, Domeboro, or saline solutions; provide atraumatic care by giving premedication before dressing change.
28
What is sunscreen?
Lotion, gel, or cream with a sun-protective factor (SPF).
29
Who should use sunscreen?
All children older than 6 months.
30
What are nursing implications for sunscreen use?
• Use fragrance-free, PABA-free preparation with SPF 15 or higher • Apply at least 30 minutes prior to sun exposure • Reapply at least every 2 hours while exposed (every 60–80 minutes in water) • Sweat- and water-resistant preparations still require reapplication • Use daily in summer and warm climates, even on overcast and cloudy days
31
What is bathing used for in skin treatment?
Use of lukewarm water (with or without soap) to bathe.
32
When is bathing indicated?
For itchy and irritating skin conditions.
33
What are nursing implications for bathing?
• Recommend fragrance-free, dye-free soaps such as Dove, Aveeno, Basis, Lubriderm • Colloids (oatmeal baths) are especially helpful • Pat the child dry, do not rub the skin • Leave the child moist before applying medication, dressing, or moisturizer
34
diaper dermatitis
An inflammatory reaction of the skin in the area covered by a diaper.
35
prolonged exposure to urine and feces
Skin breakdown.
36
important prevention strategy for diaper dermatitis
Change diapers frequently.
37
to help prevent diaper dermatitis
Rubber pants, harsh soaps, and baby wipes with fragrance or preservatives.
38
once a rash has occurred in addition to prevention tips
Allow the infant or child to go diaperless for a period of time each day to allow the rash to heal.
39
diaper area be dried when a rash is present
Blow-dry the diaper area/rash area with the dryer set on the warm (not hot) setting for 3 to 5 minutes.
40
baby powder be discouraged
To avoid the risk of aspiration; inhalation of talcum-containing powders may result in pneumonitis.
41
impetigo
A readily recognizable skin rash considered a contagious disorder, especially among vulnerable populations.
42
removal from school or day care necessary with impetigo
Removal is not necessary unless the condition is widespread or actively weeping.
43
precautions should nurses follow if a patient with impetigo is hospitalized
Follow the institution’s isolation precautions to prevent transmission of nosocomial MRSA to vulnerable or high-risk patients.
44
patients are considered vulnerable or high-risk for transmission
Premature infants, children with weak immune systems, open wounds, or invasive lines.
45
therapeutic management for impetigo
• Topical antibiotics • Systemic antibiotics • Appropriate hygiene
46
non-bullous impetigo generally follow
Some type of skin trauma or secondary bacterial infection of another skin disorder.
47
skin disruptions can lead to non-bullous impetigo
A cut, scrape, or insect or spider bite.
48
activity in adolescents can lead to impetigo
Body piercing.
49
bullous impetigo develop
On intact skin.
50
symptom may occur with bullous impetigo
Fever may occur.
51
organisms often cause impetigo
Staphylococcus aureus and group A beta-hemolytic streptococcus.
52
non-bullous impetigo usually occur
After the skin is already irritated or broken.
53
examples of causes of skin irritation leading to non-bullous impetigo
Scratching a bug bite, a cut or scrape, or another skin condition like atopic dermatitis (eczema).
54
infection occur in non-bullous impetigo
Bacteria (Staph or Strep) enter through a break in the skin and cause infection.
55
non-bullous impetigo usually form
On damaged skin.
56
bullous impetigo
Staphylococcus aureus that produces a toxin.
57
toxin do in bullous impetigo
Damages the skin’s top layer, allowing large fluid-filled blisters (bullae) to form.
58
bullous impetigo appear on healthy skin
Yes, it can appear on healthy, unbroken skin.
59
causes the separation and blistering in bullous impetigo
The toxin itself.
60
population is bullous impetigo seen more often
Infants and young children.
61
bullous impetigo develop on unbroken skin
Because the bacterial toxin damages the skin directly.
62
common concern related to bacterial skin infections
Community-acquired bacterial skin infections caused by methicillin-resistant S. aureus (CA-MRSA).
63
CA-MRSA most commonly occur
As a skin or soft tissue infection such as cellulitis or an abscess.
64
risk factors for CA-MRSA
Turf burns, towel sharing, participation in team sports, or attendance at day care or outdoor camps.
65
infected area be cultured for MRSA
If the child presents with a moderate to severe skin infection or an infection not responding as expected to therapy.
66
Burns are considered what type of injury among children and adolescents?
A common preventable mechanism of injury.
67
Which population is at highest risk for burns?
Young children.
68
In which age group is the mortality rate from burns highest?
Children younger than 5 years of age.
69
What can burn injuries cause?
Extreme pain and extensive burns can cause disfigurement.
70
What percentage of burns in young children are scald burns?
85%.
71
What percentage of burns are related to child abuse?
18%.
72
What often occurs in conjunction with burns as a result of smoke inhalation?
Carbon monoxide poisoning.
73
Who is at greater risk for carbon monoxide poisoning?
Infants and children compared to adults.
74
What is assessed in the child’s airway during the primary survey?
Whether it is patent, maintainable, or unmaintainable.
75
What findings suggest airway injury from burn or smoke inhalation?
Burns around the mouth, nose, or eyes; carbonaceous (black-colored) sputum; hoarseness or stridor.
76
What respiratory assessments are included in the primary survey?
Skin color, respiratory effort, symmetry of breathing, and breath sounds.
77
What circulation assessments are included in the primary survey?
Pulse strength, perfusion status, heart rate, and extent and location of edema.
78
What is determined during the secondary survey regarding the burn?
Burn depth.
79
How is burn extent estimated?
By determining the percentage of body surface area affected using a chart or estimating with the child’s palm size (about 1.25% of body surface area).
80
What additional assessment is included in the secondary survey?
Inspection for other traumatic injuries.
81
What should be done upon arrival when evaluating a child with burns?
Determine if intensive management is required.
82
What should be removed immediately in a child with burns?
Any smoldering clothing.
83
What history should be obtained during assessment?
A brief history of the burn circumstances.
84
Why should burn history be evaluated for consistency?
To determine whether the history sounds consistent with the type of burn injury that has occurred.
85
What does the primary survey include?
Evaluation of airway, breathing, and circulation.
86
What does the secondary survey focus on?
Evaluation of the burns and other injuries.
87
What respiratory goal is a nursing intervention for extensive burns?
Promoting oxygenation and ventilation.
88
What fluid management intervention is required in extensive burns?
Restoring and maintaining fluid volume.
89
Why must hypothermia be prevented in children with burns?
Due to loss of the protective dermis.
90
What wound care intervention is included in burn management?
Cleansing the burn.
91
Why is infection prevention important in burn care?
Prevention of infection is critical to successful outcomes.
92
How should pain be managed in children with burns?
With atraumatic care.
93
What is included in treating infected burns?
Treating infected burns.
94
What long-term intervention may be required after burns?
Providing burn rehabilitation.
95
How are burn infections treated?
With antibiotics specific to the causative organism.
96
When might surgery be needed for burn injuries?
If invasive burn damage occurs.
97
What are findings of superficial burns?
Red skin and pain at site.
98
What are findings of partial thickness burns?
Blisters, intense pain, white to red skin, moist and mottled skin.
99
What are findings of full thickness burns?
Charring, dark brown or white skin, skin hard to the touch, little or no pain, pain at the periphery of burn.
100
Who developed criteria for referral to a specialized burn unit?
The American Burn Association.
101
What burn size requires transfer to a burn center?
Partial-thickness burns greater than 10% of total body surface area.
102
What burn locations require transfer to a burn center?
Burns involving the face, hands and feet, genitalia, perineum, or major joints.
103
What burn depth requires transfer regardless of size?
Full-thickness burns of any size.
104
What types of burns require transfer to a burn center?
Chemical or electrical burns, including lightning injury.
105
What inhalation-related condition requires transfer?
Inhalation injury.
106
Which children with burns should be transferred due to medical complexity?
Children with pre-existing conditions that might affect their care.
107
Which trauma situation requires burn center transfer?
Persons with burns and traumatic injuries.
108
What social or rehabilitation needs require transfer?
Persons who will require special social, emotional, or long-term rehabilitative care.
109
When should burned children be transferred due to facility limitations?
When the hospital lacks qualified personnel or equipment for the care of children.
110
How does fluid loss from burned skin compare to undamaged skin?
Fluid loss from burned skin occurs at an amount five to ten times greater than from undamaged skin.
111
How long does fluid loss continue after a burn?
Until the damaged surface is healed or grafted.
112
What is fluid calculation based on in burn resuscitation?
The body surface area burned.
113
What type of fluid is used during the first 24 hours?
A crystalloid (Ringer’s lactate).
114
What may be added for smaller children during fluid resuscitation?
A small amount of dextrose.
115
When is most of the fluid volume administered during burn resuscitation?
During the first 8 hours.
116
What is important regarding reassessment during fluid resuscitation?
Reassessment of the child and adjustment of the fluid rate accordingly.
117
How do fluid requirements change after 24 hours?
Fluid requirements greatly decrease and should be adjusted to reflect this.
118
When may colloid fluids be administered?
Later in therapy once capillary permeability is less of a concern.
119
What urine output is expected during monitoring of response to therapy?
At least 1 mL/kg/h.
120
What is the best indicator of fluid volume status?
Daily weights obtained at the same time each day.
121
Which electrolytes should be monitored?
Particularly sodium and potassium for return to normal levels.
122
What is necessary but often extremely painful in burn care?
Debridement.
123
What aspect of care is of utmost importance during burn treatment?
Pain management needs of the child.
124
What atraumatic care method can provide cognitive distraction during dressing changes?
Immersion in virtual reality computer games before and during burn dressing changes.
125
Why can severity of electrical injury be difficult to assess?
Most damage happens under the skin (“iceberg effect”).
126
What cardiac complication may occur after an electrical burn?
Cardiac arrhythmias.
127
How long after an electrical burn injury can cardiac arrhythmias be noted?
Up to 72 hours after injury.
128
What is important after an electrical burn injury?
Monitoring.
129
What laboratory tests are included in burn evaluation?
Electrolytes and complete blood count.
130
What wound-related diagnostic test may be performed?
Culture of wound drainage.
131
What nutritional assessment is included in burn diagnostics?
Nutritional indices.
132
What respiratory assessment is included in burn diagnostics?
Pulmonary status.
133
What imaging or assessment may be done for inhalation injury?
Scanning for inhalation injury.
134
What monitoring is required for electrical injury?
Electrocardiographic monitoring.
135
What should nurses be alert for when assessing burns?
Inconsistencies between the history and the clinical picture.
136
What could inconsistencies between history and injury indicate?
Child abuse.
137
How do spatter-type burns usually appear?
Nonuniform, asymmetric distribution of injury.
138
How do intentional scald injuries often appear?
A uniform “stocking” or “glove” distribution when the child’s extremity is held under very hot water.
139
What history pattern may suggest abuse?
Inconsistent history when caregivers are interviewed separately.
140
What treatment-related behavior may suggest abuse?
Delay in seeking treatment by caregiver.
141
What burn appearance may suggest abuse?
Uniform appearance with clear delineation of burned and nonburned area.
142
What scald injury finding may suggest forced immersion?
Lack of spattering with evidence of “porcelain-contact sparing.”
143
What burn pattern may suggest abuse involving extremities?
Flexor-sparing burns or burns involving the dorsum of the hand.
144
What circumferential burn pattern may indicate abuse?
A stocking/glove pattern on the hands or feet.
145
What temperature should hot water heaters be kept below?
Lower than 49°C (120°F).
146
What should be done before bathing children?
Test bath water temperature.
147
What heat sources should children be kept away from?
Open flames, stoves, and candles.
148
How should pots be positioned while cooking?
On the inside of the stove with handles turned in.
149
What should children do while cooking is occurring?
Be kept away from the stove.
150
Where should hot liquids be kept?
Out of reach of children.
151
What should be avoided while holding a child?
Drinking hot beverages.
152
What appliance should be kept out of reach of children?
Curling irons.
153
What fire safety teaching should older children receive?
How to safely get out of the house in case of fire.
154
What fire safety activity should families practice?
Fire drills.
155
What should children be taught if their clothes catch fire?
“Stop, drop, and roll.”
156
What can altered body image perception/disturbances related to injury or alteration in body function cause in children?
A significant impact on children.
157
What examples contribute to altered body image perception in children with integumentary disorders?
Chronic skin changes or burns as evidenced by a child’s negative feeling about body or fear of reaction by others.
158
What is an appropriate nursing intervention related to emotional response to skin changes?
Acknowledge feelings of anger or depression related to skin changes to provide an outlet for feelings.
159
What therapies may benefit children experiencing psychosocial impact from skin changes?
Regular counseling and group therapy.
160
What should nurses help the child or teen do regarding self-perception?
Help the child or teen accept self as the perception of self is tied to knowing oneself and identifying self-values.
161
What type of reaction do stings and bites usually result in?
A local reaction.
162
Many allergic reactions occur due to stings from which insects?
Bees, wasps, ants, yellow jackets, and hornets.
163
What serious reaction may occur from insect stings?
Systemic or anaphylactic reaction possibly resulting in airway compromise.
164
How do spiders cause injury?
Spiders inject their venom when they bite.
165
Which spider bites can cause serious reactions?
Brown recluse or black widow spider bites.
166
What reactions may occur from insect stings and spider bites?
Pruritus, pain, and edema.
167
What therapeutic management is used for insect stings and spider bites?
Antihistamines to decrease itching and in some cases corticosteroids to decrease inflammation and swelling.
168
What commonly results in significant emergency room visits related to animal injuries?
Bites from mammals.
169
Which animal bites account for the majority of injuries?
Dog bites.
170
When is rabies prophylaxis needed after a dog bite?
If the rabies status of the dog is unknown.
171
Which bites account for the most infected bites among children?
Human and cat bites.
172
What should children/families be taught about interacting with dogs?
Never provoke a dog with teasing or roughhousing.
173
What should children do before interacting with an unfamiliar animal?
Get adult permission before interacting with a dog, cat, or other animal that is not your pet.
174
What situations should children avoid with dogs?
Do not bother an eating, sleeping, or nursing dog.
175
What behavior should be avoided around dogs?
Avoid high-pitched talking or screaming around dogs.
176
How should a child allow a dog to become familiar with them?
Display a closed fist first for the dog to sniff.
177
What safety teaching is given regarding ferrets?
Keep ferrets away from the face.
178
What should a child do if a cat hisses or lashes out with the paw?
Leave it alone.
Peds Exam 2 Chapter 45
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